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Query: UMLS:C0024623 (gastric cancer)
 36,219 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Dyspepsia is a common problem in ambulatory care. While many authorities recommend ordering upper gastrointestinal x-ray series (UGI) before therapy, there is evidence that clinicians frequently treat dyspepsia without diagnostic procedures. Decision analysis was performed to select optimal management based on probabilities and outcome values from the published literature. The choices evaluated were Symptomatic Therapy (low dose antacids or anticholinergics), Ulcer Therapy (high dose antacids or cimetidine), or UGI followed by further tests or therapy. Our model indicates that mortality is minimized if UGI is performed prior to selection of therapy, and if endoscopy is performed when the x ray shows gastric ulcer. Weeks of pain are minimized if Ulcer Therapy is begun immediately, but direct health care costs are minimized by beginning with Symptomatic Therapy. The marginal cost per additional life saved by performing a UGI rather than beginning with Ulcer Therapy was +1.6 million to +2.3 million, depending on whether endoscopy followed the finding of gastric ulcer. Mortality advantages of the strategies beginning with UGI were sensitive to assumptions regarding the incidence of gastric cancer and the benefits of early diagnosis. With slight reductions in these base case values, the Ulcer Therapy strategy appeared to minimize all outcomes except dollar cost.
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PMID:Diagnosis and treatment of dyspepsia. A cost-effectiveness analysis. 682 Jun 78

Early gastric cancer confined to the mucosa or submucosa, similar to that described in the Japanese literature, exists in Newfoundland, on area of North America in which gastric cancer is four times more prevalent that on the rest of the continent. If untreated, this early gastric cancer will progress to advanced disease. The clinical presentation of 10 patients suffering from cancer confined to the mucosa and submucosa of the stomach is described. The disease presents with acute or chronic bleeding or unexplained dyspepsia; no abnormality of the stomach can be seen on roentgenograms. The diagnosis may be suspected at endoscopic examination. Cytologic studies using touch preparations may be suggestive but the diagnosis should be confirmed by biopsy before operation is performed.
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PMID:Early gastric cancer. 705 71

Of the N-nitroso compounds derived from precursors in gastric juice, only a very small proportion are in the form of volatile N-nitrosamines. However, about 40% of the remainder can be converted by methylation into a form(s) suitable for gas chromatography. In this way, at least 20 individual peaks were detected with the Thermal Energy Analyzer as detector. N-Nitroso compounds have been determined as a group in the fasting gastric juice of normal individuals and patients with conditions including duodenal ulcer, gastric ulcer, atrophic gastritis, pernicious anaemia, gastric carcinoma, dyspepsia with normal endoscopy or subjected to operative procedures, such as vagotomy or partial gastrectomy. Both the levels of N-nitroso compounds and pH values increased significantly with age in normal subjects and in those with pathological conditions. Sex and cigarette smoking had no significant influence. In particular, a positive correlation was found between pH and the level of N-nitroso compounds, with a p value of less than or equal to 10(-6). Their concentration rose from a geometric mean of 0.11 mumol.1(-1) at pH 1.0-1.5, to a value of 1.3 mumol.1(-1) within the pH range 6.5-9.0. Whilst quantitative bacteriology was not carried out, a highly significant relationship was also observed between the concentration of N-nitroso compounds and the availability of nitrate-reducing bacteria. Thus, conditions conducive to gastric cancer are associated with higher levels of compounds responding to group analysis as N-nitrosamines and/or N-nitrosamides.
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PMID:N-nitroso compounds in gastric juice and their relationship to gastroduodenal disease. 714 42

Sixteen patients with early gastric cancer (carcinoma which is confined to mucosa and submucosa) are described. Despite a long duration of symptoms and frequently large tumour surface areas, lymph-node metastasis occurred in only one patient. Findings of endoscopic biopsy were more accurate (100%) than endoscopic (75%), radiological (50%), or clinical features in diagnosing malignancy. However, only an average of 58% of biopsy specimens demonstrated cancer, which emphasises the need for multiple biopsies. After resection, no deaths due to cancer occurred during a mean follow-up period of 28 months. Endoscopy, plus carefully directed biopsy when a lesion is found, should be performed in patients with dyspepsia in whom X-ray examination reveals no abnormality, and in those with persistent symptoms in the upper gastrointestinal tract. Such an approach is a prerequisite to the accurate diagnosis of gastric cancer in its early, curable, stage.
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PMID:Early gastric cancer. 714 72

By means of Eysenck's Maudsley Personality Inventory (MPI), the personality dimensions neuroticism and extraversion were estimated in 1148 control probands (m. 195; f. 953), in 375 patients with x-ray negative dyspepsia (m. 233; f. 142), in 77 males with duodenal ulcer, 42 patients with gastric ulcer (m. 25; f. 17), and 27 patients with gastric cancer (m. 18; f. 9). In x-ray negative dyspepsia and in duodenal ulcer, slightly higher scores for neuroticism and lower scores for extraversion than in controls were found whereas patients with stomach cancer and gastric ulcer are characterized by high emotional stability. It is assumed that knowledge of the patient's personality structure may improve the physician-patient relationship.
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PMID:[Investigation of personality structure by MPI in patients with gastric diseases (author's transl)]. 741 41

The majority of patients with dyspepsia are managed in general practice. However, most of the literature on Helicobacter pylori and its association with gastrointestinal disease has originated from secondary care. This review summarizes the role of H pylori in dyspepsia from the perspective of primary care and suggests a new strategy for the management of dyspeptic patients in this setting. Recent meta-analyses and consensus statements have supported the use of eradication therapy as first-line treatment of peptic ulceration. Studies from primary care have supported the use of eradication therapy in patients who have H pylori related peptic ulcer disease and require long-term H2-antagonist medication, on both clinical benefit and cost-effectiveness grounds. Of the many regimens proposed for the eradication of H pylori, the best evidence supports a triple combination of bismuth, metronidazole and tetracycline. Regimens using proton pump inhibitors may be more acceptable to patients but lack good evidence from trials. Use of a positive serum enzyme-linked immunoabsorbent assay for H pylori antibodies as a criterion for endoscopic investigation has been shown to result in a 23% reduction in endoscopic workload. Further research should answer questions of importance to general practitioners, such as the role of eradication therapy in patients with nonulcer dyspepsia and the effectiveness of eradication of H pylori in the prevention of gastric cancer.
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PMID:Role of Helicobacter pylori in gastrointestinal disease: implications for primary care of a revolution in management of dyspepsia. 874 55

There is evidence that Helicobacter pylori infection is associated with gastric cancer and mucosa-associated lymphoid tissue (MALT) lymphoma and possibly with non-ulcer dyspepsia. Eradication therapy for confirmed H. pylori infection may therefore become mandatory in patients with non-ulcer dyspepsia severe enough to warrant endoscopy and in first-degree relatives of patients with gastric cancer. However, routine treatment of asymptomatic carriers awaits confirmation of the association with cancer.
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PMID:Helicobacter pylori and gastric neoplasia: evolving concepts. 756 11

The objective of this study was to conduct a survey of the opinions and practices of gastroenterologists in the United Kingdom concerning the impact of Helicobacter pylori infection on the management of upper gastrointestinal diseases. A postal questionnaire was sent to all medically qualified members of the British Society of Gastroenterology working in the UK. Replies were received from 670 of 1037 eligible BSG members (65%). Of these, 73% thought that H pylori was a cause of duodenal ulcer and 84% thought that eradication of H pylori decreased ulcer recurrence in comparison with acid suppression. While 80% used anti-H pylori therapy for a chronic relapsing duodenal ulcer, only 25% used such therapy for an ulcer at first presentation and 17% never used anti-H pylori therapy for patients with duodenal ulcer. Although 75% of respondents did not agree that H pylori was a cause of non-ulcer dyspepsia, 69% used anti-H pylori therapy to treat a patient with this condition. At the time of the survey, 69% of those who used anti-H pylori therapy adopted some variant of standard triple therapy. Only 7% routinely tested for bacterial sensitivity to antibiotics and only 22% assessed their patients for eradication after treatment. There was a lack of consensus about whether H pylori was a cause of gastric ulcer or gastric cancer with only 47% and 17% respectively believing in these associations. In conclusion, at the time of the survey, the use of anti-H pylori therapy had been accepted by a majority of specialist UK gastroenterologists in the management of upper gastrointestinal disease. There was, however, a substantial degree of uncertainty and divergence about which patients should be treated.
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PMID:Helicobacter pylori and upper gastrointestinal disease: a survey of gastroenterologists in the United Kingdom. 759 Apr 23

Helicobacter pylori is present worldwide but few large population studies exist on the epidemiology of the infection. A random cross sectional study was performed of H pylori infection in the adult population of San Marino, a European country with high gastric cancer rate, to assess its prevalence and to evaluate its relations with gastrointestinal disease. In 2237 subjects (77% of the initial sample) H pylori IgG antibodies were detected with enzyme linked immunosorbent assay (ELISA) and immunoblotting. A questionnaire including questions about occupation, place of birth, and smoking was given to all subjects. Dyspepsia, peptic ulcer, and gastric cancer in the subjects, relatives, and partners as well as use of drug, dental treatment/prostheses, and gastrointestinal endoscopies, were evaluated by multivariate analysis. H pylori prevalence was of 51%, increased with age from 23% (20-29 years) to 68% (> or = 70 years), and was higher among manual workers. H pylori was independently associated with ulcer (OR = 1.63, 95% confidence intervals (CI) = 1.16 to 2.27), H2 antagonists (OR = 1.94, 95% CI = 1.21 to 3.10), and benzodiazepines (OR = 1.57, 95% CI = 1.02 to 2.42), dental prostheses (OR = 1.25, 95% CI = 1.05 to 1.49), gastroscopy in the past five years (OR = 1.50, 95% CI = 1.05 to 2.14), peptic ulcer in siblings (OR = 1.52, 95% CI = 1.09 to 2.12), gastric cancer in father (OR = 1.61, 95% CI = 1.02 to 2.52). The association of seropositivity with history of ulcer, gastric cancer in family, gastroscopy, and H2 antagonists suggests that H pylori is an epidemiological key factor in the pathogenesis of gastroduodenal diseases in this area.
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PMID:A population based study of Helicobacter pylori infection in a European country: the San Marino Study. Relations with gastrointestinal diseases. 761 70

A cytotoxin produced by some Helicobacter pylori strains has recently been identified. The cytotoxin induces intracellular vacuolization of cultured cells. The aim of the present study was to examine the frequency of occurrence of cytotoxin-producing strains of H. pylori from subjects with upper gastrointestinal disease including nonulcer dyspepsia, gastric and duodenal ulcer disease, gastroesophageal reflux disease, and gastric cancer. Broth culture filtrates of clinical isolates of H. pylori recovered from 175 patients were used to inoculate Vero and HeLa cell monolayers for the detection of vacuolating cytotoxin activity. The results obtained demonstrated that the highest percentage of strains producing cytotoxin were found in subjects with peptic ulcer disease (gastric ulcer, 65%; duodenal ulcer, 66%; P < 0.01 compared with nonulcer dyspepsia, 38%). Of the 11 patients with gastroesophageal reflux disease, 4 of 5 patients in this group who had esophageal ulcers, were found to be infected with strains that produced cytotoxin. Three of the four patients with carcinoma of the stomach were also found to be infected with cytotoxic strains of H. pylori. With increasing severity of mucosal damage in subjects with a normal upper gastrointestinal tract, macroscopic gastritis, duodenitis, and peptic ulceration, there were corresponding increase in the proportion of strains producing cytotoxin; these increases were 32, 46, 50, and 66%, respectively. H. pylori strains from subjects with ulcer disease commonly produced vacuolating cytotoxin, suggesting that it may be a virulence factor in the pathogenesis of peptic ulcer disease.
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PMID:Cytotoxin production by Helicobacter pylori from patients with upper gastrointestinal tract diseases. 761 29


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